Framing a global health risk from the bottom-up: user perceptions and practices around antibiotics in four villages in China

This paper describes an exploratory study that investigated perceptions and practices around antibiotic use amongst villagers in four villages in Hubei and Shandong, China, as part of a larger multi-level project investigating framings of technology risk and regulation from local to global levels. Adopting a ‘backward-mapping’ methodology, focus group discussions and in depth interviews were carried out during a field visit in the summer of 2008 to examine notions of antibiotics as a category of drug, their uses, patient preferences and strategies for managing risk by accessing what were seen as ‘better’ antibiotics. Most villagers, especially those identified by peers as coming from poorer groups, expressed their ignorance around antibiotics and admitted relying entirely on trusted doctors to provide information and administer drugs. The minority of villagers who differentiated between antibiotics and other drugs claimed to base their knowledge additionally upon their own experience with the drugs, and in some cases on information from the media. Villagers’ explanations for the high level of use of antibiotics (including drips) to treat infections such as common colds, and villagers’ awareness and understanding of antibiotic resistance are explored. We finally discuss the implications of these user ‘framings’ for international and national initiatives to manage the global threat of antibiotic resistance